Detection of architectural distortion in prior mammograms via analysis of oriented patterns.

We demonstrate methods for the detection of architectural distortion in prior mammograms of interval-cancer cases based on analysis of the orientation of breast tissue patterns in mammograms. We hypothesize that architectural distortion modifies the normal orientation of breast tissue patterns in mammographic images before the formation of masses or tumors. In the initial steps of our methods, the oriented structures in a given mammogram are analyzed using Gabor filters and phase portraits to detect node-like sites of radiating or intersecting tissue patterns. Each detected site is then characterized using the node value, fractal dimension, and a measure of angular dispersion specifically designed to represent spiculating patterns associated with architectural distortion. Our methods were tested with a database of 106 prior mammograms of 56 interval-cancer cases and 52 mammograms of 13 normal cases using the features developed for the characterization of architectural distortion, pattern classification via quadratic discriminant analysis, and validation with the leave-one-patient out procedure. According to the results of free-response receiver operating characteristic analysis, our methods have demonstrated the capability to detect architectural distortion in prior mammograms, taken 15 months (on the average) before clinical diagnosis of breast cancer, with a sensitivity of 80% at about five false positives per patient.

Measures of angular spread and entropy for the detection of architectural distortion in prior mammograms.

PURPOSE: Architectural distortion is an important sign of early breast cancer. We present methods for computer-aided detection of architectural distortion in mammograms acquired prior to the diagnosis of breast cancer in the interval between scheduled screening sessions. METHODS: Potential sites of architectural distortion were detected using node maps obtained through the application of a bank of Gabor filters and linear phase portrait modeling. A total of 4,224 regions of interest (ROIs) were automatically obtained from 106 prior mammograms of 56 interval-cancer cases, including 301 true-positive ROIs, and from 52 mammograms of 13 normal cases. Each ROI was represented by three types of entropy measures of angular histograms composed with the Gabor magnitude response, angle, coherence, orientation strength, and the angular spread of power in the Fourier spectrum, including Shannon's entropy, Tsallis entropy for nonextensive systems, and Rényi entropy for extensive systems. RESULTS: Using the entropy measures with stepwise logistic regression and the leave-one-patient-out method for feature selection and cross-validation, an artificial neural network resulted in an area under the receiver operating characteristic curve of 0.75. Free-response receiver operating characteristics indicated a sensitivity of 0.80 at 5.2 false positives (FPs) per patient. CONCLUSION: The proposed methods can detect architectural distortion in prior mammograms taken 15 months (on the average) before clinical diagnosis of breast cancer, with a high sensitivity and a moderate number of FPs per patient. The results are promising and may be improved with additional features to characterize subtle abnormalities and larger databases including prior mammograms.

Measures of divergence of oriented patterns for the detection of architectural distortion in prior mammograms.

PURPOSE: We propose a method for the detection of architectural distortion in prior mammograms of interval-cancer cases based on the expected orientation of breast tissue patterns in mammograms. METHODS: The expected orientation of the breast tissue at each pixel was derived by using automatically detected landmarks including the breast boundary, the nipple, and the pectoral muscle (in mediolateral-oblique views). We hypothesize that the presence of architectural distortion changes the normal expected orientation of breast tissue patterns in a mammographic image. The angular deviation of the oriented structures in a given mammogram as compared to the expected orientation was analyzed to detect potential sites of architectural distortion using a measure of divergence of oriented patterns. Each potential site of architectural distortion was then characterized using measures of spicularity and angular dispersion specifically designed to represent spiculating patterns. The novel features for the characterization of spiculating patterns include an index of divergence of spicules computed from the intensity image and Gabor magnitude response using the Gabor angle response; radially weighted difference and angle-weighted difference (AWD) measures of the intensity, Gabor magnitude, and Gabor angle response; and AWD in the entropy of spicules computed from the intensity, Gabor magnitude, and Gabor angle response. RESULTS: Using the newly proposed features with a database of 106 prior mammograms of 56 interval-cancer cases and 52 mammograms of 13 normal cases, through feature selection and pattern classification with an artificial neural network, an area under the receiver operating characteristic curve of 0.75 was obtained. Free-response receiver operating characteristic analysis indicated a sensitivity of 0.80 at 5.3 false positives (FPs) per patient. Combining the features proposed in the present paper with others described in our previous works led to significant improvement with a sensitivity of 0.80 at 3.7 FPs per patient. CONCLUSION: The proposed methods can detect architectural distortion in prior mammograms taken 15 months (on the average) before clinical diagnosis of breast cancer, but the FP rate needs to be reduced.

Detection of architectural distortion in prior mammograms.

We present methods for the detection of sites of architectural distortion in prior mammograms of interval-cancer cases. We hypothesize that screening mammograms obtained prior to the detection of cancer could contain subtle signs of early stages of breast cancer, in particular, architectural distortion. The methods are based upon Gabor filters, phase portrait analysis, a novel method for the analysis of the angular spread of power, fractal analysis, Laws' texture energy measures derived from geometrically transformed regions of interest (ROIs), and Haralick's texture features. With Gabor filters and phase portrait analysis, 4224 ROIs were automatically obtained from 106 prior mammograms of 56 interval-cancer cases, including 301 true-positive ROIs related to architectural distortion, and from 52 mammograms of 13 normal cases. For each ROI, the fractal dimension, the entropy of the angular spread of power, 10 Laws' measures, and Haralick's 14 features were computed. The areas under the receiver operating characteristic curves obtained using the features selected by stepwise logistic regression and the leave-one-ROI-out method are 0.76 with the Bayesian classifier, 0.75 with Fisher linear discriminant analysis, and 0.78 with a single-layer feed-forward neural network. Free-response receiver operating characteristics indicated sensitivities of 0.80 and 0.90 at 5.8 and 8.1 false positives per image, respectively, with the Bayesian classifier and the leave-one-image-out method.

Computer-aided detection of architectural distortion in prior mammograms of interval cancer.

Architectural distortion is an important sign of breast cancer, but because of its subtlety, it is a common cause of false-negative findings on screening mammograms. This paper presents methods for the detection of architectural distortion in mammograms of interval cancer cases taken prior to the detection of breast cancer using Gabor filters, phase portrait analysis, fractal analysis, and texture analysis. The methods were used to detect initial candidates for sites of architectural distortion in prior mammograms of interval cancer and also normal control cases. A total of 4,224 regions of interest (ROIs) were automatically obtained from 106 prior mammograms of 56 interval cancer cases, including 301 ROIs related to architectural distortion, and from 52 prior mammograms of 13 normal cases. For each ROI, the fractal dimension and Haralick's texture features were computed. Feature selection was performed separately using stepwise logistic regression and stepwise regression. The best results achieved, in terms of the area under the receiver operating characteristics curve, with the features selected by stepwise logistic regression are 0.76 with the Bayesian classifier, 0.73 with Fisher linear discriminant analysis, 0.77 with an artificial neural network based on radial basis functions, and 0.77 with a support vector machine. Analysis of the performance of the methods with free-response receiver operating characteristics indicated a sensitivity of 0.80 at 7.6 false positives per image. The methods have good potential in detecting architectural distortion in mammograms of interval cancer cases.

Detection of architectural distortion in prior mammograms of interval-cancer cases with neural networks.

Architectural distortion is a commonly missed sign of breast cancer. This paper investigates the detection of architectural distortion, in mammograms of interval-cancer cases taken prior to the diagnosis of breast cancer, using Gabor filters, phase portrait analysis, fractal dimension, and texture analysis. The methods were used to detect initial candidates for sites of architectural distortion in prior mammograms of interval-cancer and also normal cases. A total of 4212 regions of interest (ROIs) were automatically obtained from 106 prior mammograms of 56 interval-cancer cases, including 262 ROIs related to architectural distortion, and from 52 prior mammograms of 13 normal cases. For each ROI, the fractal dimension and Haralick's texture features were computed. Feature selection was performed using stepwise logistic regression and in terms of the area under the receiver operating characteristics (ROC) curve (AUC). The best results achieved, in terms of AUC, are 0.75 with the Bayesian classifier, 0.71 with Fisher linear discriminant analysis, and 0.76 with an artificial neural network (ANN) based on radial basis functions (RBF). Analysis of the performance of the methods with free-response receiver operating characteristics indicated a sensitivity of 0.80 at 10.5 false positives per image.

Identification of the breast boundary in mammograms using active contour models.

A method for the identification of the breast boundary in mammograms is presented. The method can be used in the preprocessing stage of a system for computer-aided diagnosis (CAD) of breast cancer and also in the reduction of image file size in picture archiving and communication system applications. The method started with modification of the contrast of the original image. A binarisation procedure was then applied to the image, and the chain-code algorithm was used to find an approximate breast contour. Finally, the identification of the true breast boundary was performed by using the approximate contour as the input to an active contour model algorithm specially tailored for this purpose. After demarcation of the breast boundary, all artifacts outside the breast region were eliminated. The method was applied to 84 medio-lateral oblique mammograms from the Mini-MIAS database. Evaluation of the detected breast boundary was performed based upon the percentage of false-positive and false-negative pixels determined by a quantitative comparison between the contours identified by a radiologist and those identified by the proposed method. The average false positive and false negative rates were 0.41% and 0.58%, respectively. The two radiologists who evaluated the results considered the segmentation results to be acceptable for CAD purposes.

Automatic identification of the pectoral muscle in mammograms.

The pectoral muscle represents a predominant density region in most medio-lateral oblique (MLO) views of mammograms; its inclusion can affect the results of intensity-based image processing methods or bias procedures in the detection of breast cancer. Local analysis of the pectoral muscle may be used to identify the presence of abnormal axillary lymph nodes, which may be the only manifestation of occult breast carcinoma. We propose a new method for the identification of the pectoral muscle in MLO mammograms based upon a multiresolution technique using Gabor wavelets. This new method overcomes the limitation of the straight-line representation considered in our initial investigation using the Hough transform. The method starts by convolving a group of Gabor filters, specially designed for enhancing the pectoral muscle edge, with the region of interest containing the pectoral muscle. After computing the magnitude and phase images using a vector-summation procedure, the magnitude value of each pixel is propagated in the direction of the phase. The resulting image is then used to detect the relevant edges. Finally, a post-processing stage is used to find the true pectoral muscle edge. The method was applied to 84 MLO mammograms from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database. Evaluation of the pectoral muscle edge detected in the mammograms was performed based upon the percentage of false-positive (FP) and false-negative (FN) pixels determined by comparison between the numbers of pixels enclosed in the regions delimited by the edges identified by a radiologist and by the proposed method. The average FP and FN rates were, respectively, 0.58% and 5.77%. Furthermore, the results of the Gabor-filter-based method indicated low Hausdorff distances with respect to the hand-drawn pectoral muscle edges, with the mean and standard deviation being 3.84 +/- 1.73 mm over 84 images.

Analysis of asymmetry in mammograms via directional filtering with Gabor wavelets.

This paper presents a procedure for the analysis of left-right (bilateral) asymmetry in mammograms. The procedure is based upon the detection of linear directional components by using a multiresolution representation based upon Gabor wavelets. A particular wavelet scheme with two-dimensional Gabor filters as elementary functions with varying tuning frequency and orientation, specifically designed in order to reduce the redundancy in the wavelet-based representation, is applied to the given image. The filter responses for different scales and orientation are analyzed by using the Karhunen-Loève (KL) transform and Otsu's method of thresholding. The KL transform is applied to select the principal components of the filter responses, preserving only the most relevant directional elements appearing at all scales. The selected principal components, thresholded by using Otsu's method, are used to obtain the magnitude and phase of the directional components of the image. Rose diagrams computed from the phase images and statistical measures computed thereof are used for quantitative and qualitative analysis of the oriented patterns. A total of 80 images from 20 normal cases, 14 asymmetric cases, and six architectural distortion cases from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database were used to evaluate the scheme using the leave-one-out methodology. Average classification accuracy rates of up to 74.4% were achieved.

Detection of breast masses in mammograms by density slicing and texture flow-field analysis.

We propose a method for the detection of masses in mammographic images that employs Gaussian smoothing and sub-sampling operations as preprocessing steps. The mass portions are segmented by establishing intensity links from the central portions of masses into the surrounding areas. We introduce methods for analyzing oriented flow-like textural information in mammograms. Features based on flow orientation in adaptive ribbons of pixels across the margins of masses are proposed to classify the regions detected as true mass regions or false-positives (FPs). The methods yielded a mass versus normal tissue classification accuracy represented as an area (Az) of 0.87 under the receiver operating characteristics (ROCs) curve with a dataset of 56 images including 30 benign disease, 13 malignant disease, and 13 normal cases selected from the mini Mammographic Image Analysis Society database. A sensitivity of 81% was achieved at 2.2 FPs/image. Malignant tumor versus normal tissue classification resulted in a higher Az value of 0.9 under the ROC curve using only the 13 malignant and 13 normal cases with a sensitivity of 85% at 2.45 FPs/image. The mass detection algorithm could detect all the 13 malignant tumors successfully, but achieved a success rate of only 63% (19/30) in detecting the benign masses. The mass regions that were successfully segmented were further classified as benign or malignant disease by computing five texture features based on gray-level co-occurrence matrices (GCMs) and using the features in a logistic regression method. The features were computed using adaptive ribbons of pixels across the boundaries of the masses. Benign versus malignant classification using the GCM-based texture features resulted in Az = 0.79 with 19 benign and 13 malignant cases.

Gradient and texture analysis for the classification of mammographic masses.

Computer-aided classification of benign and malignant masses on mammograms is attempted in this study by computing gradient-based and texture-based features. Features computed based on gray-level co-occurrence matrices (GCMs) are used to evaluate the effectiveness of textural information possessed by mass regions in comparison with the textural information present in mass margins. A method involving polygonal modeling of boundaries is proposed for the extraction of a ribbon of pixels across mass margins. Two gradient-based features are developed to estimate the sharpness of mass boundaries in the ribbons of pixels extracted from their margins. A total of 54 images (28 benign and 26 malignant) containing 39 images from the Mammographic Image Analysis Society (MIAS) database and 15 images from a local database are analyzed. The best benign versus malignant classification of 82.1%, with an area (Az) of 0.85 under the receiver operating characteristics (ROC) curve, was obtained with the images from the MIAS database by using GCM-based texture features computed from mass margins. The classification method used is based on posterior probabilities computed from Mahalanobis distances. The corresponding accuracy using jack-knife classification was observed to be 74.4%, with Az = 0.67. Gradient-based features achieved Az = 0.6 on the MIAS database and Az = 0.76 on the combined database. The corresponding values obtained using jack-knife classification were observed to be 0.52 and 0.73 for the MIAS and combined databases, respectively.

Boundary modelling and shape analysis methods for classification of mammographic masses.

The problem of computer-aided classification of benign and malignant breast masses using shape features is addressed. The aim of the study is to look at the exceptions in shapes of masses such as circumscribed malignant tumours and spiculated benign masses which are difficult to classify correctly using common shape analysis methods. The proposed methods of shape analysis treat the object's boundary in terms of local details. The boundaries of masses analysed using the proposed methods were manually drawn on mammographic images by an expert radiologist (JELD). A boundary segmentation method is used to separate major portions of the boundary and to label them as concave or convex segments. To analyse the shape information localised in each segment, features are computed through an iterative procedure for polygonal modelling of the mass boundaries. Features are based on the concavity fraction of a mass boundary and the degree of narrowness of spicules as characterised by a spiculation index. Two features comprising spiculation index (SI) and fractional concavity (fcc) developed in the present study when used in combination with the global shape feature of compactness resulted in a benign/malignant classification accuracy of 82%, with an area (Az) of 0.79 under the receiver operating characteristics (ROC) curve with a database of the boundaries of 28 benign masses and 26 malignant tumours. SI alone resulted in a classification accuracy of 80% with Az of 0.82. The combination of all the three features achieved 91% accuracy of circumscribed versus spiculated classification of masses based on shape.

Improvement of sensitivity of breast cancer diagnosis with adaptive neighborhood contrast enhancement of mammograms.

Mammograms are difficult to interpret, especially of cancers at their early stages. In this paper, we analyze the effectiveness of our adaptive neighborhood contrast enhancement (ANCE) technique in increasing the sensitivity of breast cancer diagnosis. Seventy-eight screen-film mammograms of 21 difficult cases (14 benign and seven malignant), 222 screen-film mammograms of 28 interval cancer patients and six benign control cases were digitized with a high-resolution of about 4096 x 2048 x 10-bit pixels and then processed with the ANCE method. Unprocessed and processed digitized mammograms as well as the original films were presented to six experienced radiologists for a receiver operating characteristic (ROC) evaluation for the difficult case set and to three reference radiologists for the interval cancer set. The results show that the radiologists' performance with the ANCE-processed images is the best among the three sets of images (original, digitized, and enhanced) in terms of area under the ROC curve and that diagnostic sensitivity is improved by the ANCE algorithm. All of the 19 interval cancer cases not detected with the original films of earlier mammographic examinations were diagnosed as malignant with the corresponding ANCE-processed versions, while only one of the six benign cases initially labeled correctly with the original mammograms was interpreted as malignant after enhancement. McNemar's tests of symmetry indicated that the diagnostic confidence for the interval cancer cases was improved by the ANCE procedure with a high level of statistical significance (p-values of 0.0001-0.005) and with no significant effect on the diagnosis of the benign control cases (p-values of 0.08-0.1). This study demonstrates the potential for improvement of diagnostic performance in early detection of breast cancer with digital image enhancement.

Measures of acutance and shape for classification of breast tumors.

Most benign breast tumors possess well-defined, sharp boundaries that delineate them from surrounding tissues, as opposed to malignant tumors. Computer techniques proposed to date for tumor analysis have concentrated on shape factors of tumor regions and texture measures. While shape measures based on contours of tumor regions can indicate differences in shape complexities between circumscribed and spiculated tumors, they are not designed to characterize the density variations across the boundary of a tumor. In this paper we propose a region-based measure of image edge profile acutance which characterizes the transition in density of a region of interest (ROI) along normals to the ROI at every boundary pixel. We investigate the potential of acutance in quantifying the sharpness of the boundaries of tumors, and propose its application to discriminate between benign and malignant mammographic tumors. In addition, we study the complementary use of various shape factors based upon the shape of the ROI, such as compactness, Fourier descriptors, moments, and chord-length statistics to distinguish between circumscribed and spiculated tumors. Thirty-nine images from the Mammographic Image Analysis Society (MIAS) database and an additional set of 15 local cases were selected for this study. The cases included 16 circumscribed benign, seven circumscribed malignant, 12 spiculated benign, and 19 spiculated malignant lesions. All diagnoses were proven by pathologic examinations of resected tissue. The contours of the lesions were first marked by an expert radiologist using X-Paint and X-Windows on a SUN-SPARCstation 2 Workstation. For computation of acutance, the ROI boundaries were iteratively approximated using a split/merge and end-point adjustment technique to obtain the best-fitting polygonal approximation. The jackknife method using the Mahalanobis distance measure in the BMDP (Biomedical Programs) package was used for classification of the lesions using acutance and the shape factors as features in various combinations. Acutance alone resulted in a benign/malignant classification accuracy of 95% the MIAS cases. Compactness alone gave a circumscribed/spiculated classification rate of 92.3% with the MIAS cases. Acutance in combination with a moment-based shape measure and a Fourier descriptor-based measure gave four-group classification rate of 95% with the MIAS cases. The results indicate the importance of including lesion edge definition with shape information for classification of tumors, and that the proposed measure of acutance fills this need.

Breast gigantism due to D-penicillamine.

One of the alarming side effects of D-penicillamine therapy is massive breast hypertrophy. This effect has been observed in nine patients to date. The author presents another case, including the first description of mammographic findings.

Quality assurance and cancer detection rates in a provincial screening mammography program. Work in progress.

In 1990, a provincial screening program was inaugurated in Alberta, a Canadian province of 2.4 million people. The goal of the program is to decrease the number of deaths from breast cancer by 30% in women aged 50-69 years. In the first 18 months of program operations, efforts were concentrated on high levels of quality assurance in all areas of program activities. In particular, the abnormality referral rates, cancer detection rates, and size and stage of mammographically detected cancers were evaluated. Of the 9,553 women seen, 8,524 were between the ages of 50 and 69 years. Reported abnormality rates were initially more than 16%, but were brought down steadily to less than 5%. Cancer detection rates increased with age, ranging from 1.9 cancers detected per 1,000 women aged 40-49 years to 14.1 cancers per 1,000 women aged 70 years and older. Forty-one of the 61 cancers detected (67%) were less than 1.5 cm in diameter. Forty-three of the 52 cancers (83%) in which the nodal status was known were node negative. At the conclusion of the first 18 months of operation, interpretation parameters were within the target zones expected for a population-based screening program.

Enhancement of true-positive rates for nonpalpable carcinoma of the breast through mammographic selection.

A retrospective review of 332 needle localization biopsies for nonpalpable mammographic abnormalities was performed. Twenty-one invasive and 12 noninvasive carcinomas were identified in this population, for a true positive biopsy rate of 10 percent. A review of all needle localization mammograms performed on these patients by a radiologist specializing in mammography identified 225 mammograms with a low probability of malignancy. In this group, there were four in situ and six invasive carcinomas (true positive biopsy rate of 4 percent). In the remaining 107 mammograms with a high probability of malignancy, there were eight in situ and 15 invasive carcinomas (true positive biopsy rate of 21.4 percent). In the low probability group, fine needle aspiration or excisional biopsy were recommended for six of the ten neoplasms and follow-up mammograms at three to six months for the remaining four (two in situ and two invasive carcinomas). Using selectivity, 225 biopsies could have been avoided at a savings of $97,368 (Canadian dollars) in fees for physicians alone while still identifying 29 of 33 neoplasms (87 percent of all neoplasms) and possibly delaying diagnosis for three to six months or longer in four of 33 neoplasms (13 percent, two in situ and two invasive) for which follow-up mammograms were recommended.

High-resolution digital teleradiology: a perspective.

Teleradiology has come a long way, from analog transmission systems using slow-scan television over standard telephone lines, to present-day, commercially available, microcomputer-based, low-resolution teleradiology systems. However, there exists a need to address the high-resolution end of the medical imaging categories, namely chest radiographs and mammograms, to firmly establish teleradiology. The availability of high-resolution image digitizers, display units, and digital hard copiers has made high-resolution digital teleradiology a feasible concept. Although the use of satellite channels can speed up the transmission of radiographic image data, with widespread acceptance of high-resolution teleradiology systems in the foreseeable future, the sheer amount of data involved in this field will give rise to problems of data transmission and storage. Data compression schemes can bring down the amount of data handled and can have a great economic impact on future teleradiology systems. We have developed a number of compression techniques for reversible compression of medical images. Our experiments have shown that lossless compression of the order of 4:1 is possible for a class of high-resolution medical images. Use of pattern recognition techniques offers the potential to bring down these data rates even further. We plan to use these techniques in a prototype high-resolution teleradiology system being developed. In this paper, we trace some of the developments in teleradiology and image data compression, and present a perspective for teleradiology in the 1990s.

Malignant myoepithelioma of the breast: a case report.

Myoepithelioma of the breast is rare. It is usually benign but may be locally aggressive. Its clinical behavior is unknown, but if it follows the course of similar tumors of the salivary glands, the likelihood of systemic spread is very low. Mammographic findings are nonspecific, and ultimate identification is based on ultrastructural criteria.

Pulmonary function testing in predicting complications from percutaneous lung biopsy.

Percutaneous needle biopsy is an accepted method of obtaining tissue for diagnosis of lung tumors. The depth of the lesion, size of the needle, operator experience, and the presence of emphysema have been identified as factors influencing the risk of postbiopsy pneumothorax, the most common complication. In this retrospective study of 308 patients, we enquired whether pulmonary function tests (available in 138 patients) and arterial PO2 (available in 103 patients) might predict the risk of pneumothorax following percutaneous needle biopsy. We found that as airway obstruction increases (FEV1.0/FVC less than 59% of predicted) or as arterial oxygenation decreases (PO2 less than 59 mm Hg), not only does the incidence of pneumothorax increase, but symptoms are more severe in that the number of pneumothoraces requiring chest tube drainage increases as well. We suggest that airway obstruction and arterial oxygenation are factors indicative of increased risk identifying patients who need close scrutiny after the procedure.